Student Enrolment Step 1 of 3 33% Course DetailsCourse type*Select oneMedicalMining & ConstructionElectricalSecurityEmergencyPathologyFirearms safetyI am enrolling in a medical course:*Select your specific courseUETTDRRF06 Low Voltage RescueHLTAID009 (Refresher) Provide CPRHLTAID011 Provide First Aid and HLTAID009 Provide CPRHLTAID012 Provide First Aid in education and care setting22300VIC First Aid management of AnaphylaxisVU22927 Manage Asthma risks and emergencies in the workplaceHLTAID014 Provide Advanced First AidHLTAID015 Apply Advanced Resuscitation TechniquesHLTSS00068 Occupational First Aid Skill SetPUAEME005 Pain managementI am enrolling in a mining & construction course:*Select your specific courseCPCCWHS1001 Prepare to work safely in the construction industryRIISS00034 Surface coal mine skill set (S11)RIISS00034 S11 Coal Surface Generic Induction RefresherS1,2,3 Supervisor - Coal IndustryRIIRIS402E Carry out the risk management processes (G2)RII30115 Certificate III in Surface Extraction OperationsRII40215 Certificate IV in Surface coal mining (OCE)RII40115 Certificate IV in Surface Extraction OperationsRII50115 Diploma of Surface Operations managementRIIRIS501D Implement and maintain management systems to control riskBSBWHS521 Ensure a safe workplace for a work areaRIIWHS601D Establish and maintain the WHS management system (G7))RIIRIS601D Establish and maintain the risk management system (G3))I am enrolling in an electrical course:*Select your specific courseLow Voltage Rescue UETTDRRF06I am enrolling in a security course:*Select your specific courseCertificate II in Security Operations CPP20212Crowd Control units for LicensingCash In TransitControl Security Risk using Firearms CPPSEC3008ACrowd controllers revalidation training.Speed Radar OperationsI am enrolling in an emergency course:*Select your specific courseFire WardenFire Warden & Fire ExtinguisherCPPFES2005A Demonstrate 1st attack fire fighting equipment ( Extinguisher / Hose reel / Blanket)(Fire Extinguisher) Demonstrate first attack firefighting equipmentI am enrolling in a pathology course:*Select your specific courseProvide CPR HLTAID009 (Refresher)Provide First Aid HLTAID003 and Provide CPR HLTAID001Fire WardenCPPFES2005A (Fire Extinguisher) Demonstrate first attack firefighting equipmentLow Voltage Rescue UETTDRRF06S11 Coal Surface Generic Induction RefresherS1,2,3 Supervisor - Coal IndustryG2 Supervisor Coal IndustryCertificate II in Security Operations CPP20212Crowd Control units for LicensingCash In TransitControl Security Risk using Firearms CPPSEC3008ACrowd controllers revalidation training.Drug and Alcohol testingSpeed Radar OperationsI am enrolling in a firearms safety course:*Select your specific courseProvide CPR HLTAID009 (Refresher)Provide First Aid HLTAID003 and Provide CPR HLTAID001Fire WardenCPPFES2005A (Fire Extinguisher) Demonstrate first attack firefighting equipmentLow Voltage Rescue UETTDRRF06S11 Coal Surface Generic Induction RefresherS1,2,3 Supervisor - Coal IndustryG2 Supervisor Coal IndustryCertificate II in Security Operations CPP20212Crowd Control units for LicensingCash In TransitControl Security Risk using Firearms CPPSEC3008ACrowd controllers revalidation training.Drug and Alcohol testingSpeed Radar OperationsDate of the course you are attending. (Refer to the course calendar)* DD slash MM slash YYYY (Refer to the course calendar) https://in4training.com.au/calendar/ Select the location of the course of which you will be attending*MackayRockhamptonGladstoneBundabergEmeraldSunshine Coast Shooting ClubOtherHave you completed a course with IN 4 Training previously ?* Yes No Personal DetailsThis information is required by ASQA and the information govened under privacy legislation.Your Name* First Last What is your USI (Unique Student Identifier)* Take due care. This must be correct as a certificate can not be generated and therefore issueded without a correct USI. If you do not have a USI go to www.usi.gov.au Date of Birth* DD slash MM slash YYYY Please ensure that you select the year you were born.Gender* Male Female Residential Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country NO PO Box for this question. AQSA (Federal Government) requires an actuall residential address. Postal Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country A PO Box is ok for Postal addressYour email address* Your day time phone number*Phone number Employers DetailsEmployers Name Employers Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Employers PhoneLanguage and Cultural DiversityWhich country were you born* Australia What other languages do you speak at home other than English. How well do you speak English* Very well Well Not Well Not at all Are you of Aboriginal or Torres Strait Islander origin ?* No Yes Aboriginal Yes Torres Straight Islander DisabilityDo you consider yourself to have a disability ?* No Yes If Yes, then please indicate the area of disability, impairment or long term condition. Learning dificulty / disability Intellectual disability Mental illness Vision Hearing / Deaf Physical Disability Other SchoolingWhat is your highest COMPLETED school level ?* Year 12 or Equivalent Year 11 or Equivalent Year 10 or Equivalent Year 9 or Equivalent Year 8 or Equivalent Never completed Senior school What year did you complete that school level*Please enter a number from 1950 to 2018.Are you still attending high school* Yes No Previous Qualification AchievedHave you SUCCESSFULLY completed any of the following qualifications Bachelor Degree or higher Advanced Diploma or Associate Degree Diploma / Associate Certificate IV Certificate III (or Trade Cert) Certificate I None of the above Employment* Full time employee Part time employee Casual employee Self employed Employer of others Unemployed - seeking work Not employed - not seeking work Training reason* For further education Part of my job Re qualification requirements Upskilling Recreation None of the above Why did you undertake this trainingI am aware that the information in this enrolment form may be provided to the Federal Training Authority for statistical purposes and during audit requirements* Yes No I give permission for In 4 Training to use my photograph taken during the course of my training for marketing and advertising purposes only* Yes No I understand that photo's and video may be taken and kept on file to verify assessment competency during an audit* Yes No I give permission for In 4 Training to use my feedback comments that may be used for marketing and advertising purposes* Yes No I acknowledge that I have access to the student hand book via the IN 4 Training website home page and that I accept these terms and conditions* Yes No Signature*